Provider Demographics
NPI:1164476115
Name:RIVERBEND HEAD START & FAMILY SERVICES
Entity Type:Organization
Organization Name:RIVERBEND HEAD START & FAMILY SERVICES
Other - Org Name:TRANSITIONS COUNSELING
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOFFET
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW LCPC
Authorized Official - Phone:618-463-5927
Mailing Address - Street 1:550 LANDMARKS BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-7304
Mailing Address - Country:US
Mailing Address - Phone:618-463-5927
Mailing Address - Fax:618-463-5965
Practice Address - Street 1:3550 COLLEGE AVE
Practice Address - Street 2:STE C
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-7304
Practice Address - Country:US
Practice Address - Phone:618-463-5927
Practice Address - Fax:618-463-5965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3741717016Medicaid
IL3741717016Medicaid